Insurance Law Flashcards
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An arrangement where an individual is authorized to act on behalf of another person or company is established through
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the law of agency
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The powers directly given to a producer in an agency contract are called
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express
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An insurance application requires an applicant to make a full, accurate disclosure of the risk factor involved. Using this criteria, an insurance policy is considered what type of contract?
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Contract of utmost good faith
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What qualifies as acceptance of an insurance contract offer?
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An issued policy
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How long does one premium payment cover in a single premium whole life policy?
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Entire life of the policy
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Which action will trigger a penalty tax on premature distributions from a modified endowment contract (MEC)?
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policy loans
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What type of premiums are associated with individual mortgage protection life insurance policies?
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Level premiums
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Which statement regarding whole life insurance is accurate?
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Insurance coverage can continue for life
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How long does protection normally extend to under a limited pay whole life policy?
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Until age 100
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When does the insured stop making payments under a thirty-payment whole life policy?
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At the time of death or 30 years after the policy's inception, whichever comes first
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What type of life insurance policy covers two or more persons and pays the face amount upon the death of the first insured?
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Joint life
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Which of the following combinations best describe a universal life insurance policy?
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A flexible premium deposit fund and a monthly renewable term insurance policy
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A policyowner is permitted to take out a policy loan on a whole life policy at what point?
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When the policy has a cash value
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A source of additional income for a life insurance policyowner can be derived from the
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cash value
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A life insurance policy's waiver of premium rider has the ability to
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relieve the insured of premium payments following an initial waiting period after the insured becomes totally disabled
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What could be the potential result of taking out a cash value loan on a life insurance policy?
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Cash surrender value will be reduced if policy is forfeited
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What happens to the death benefit of a life insurance policy if the insured elects a partial payment from the accelerated (living) benefit provision?
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Reduced
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How is the insured protected if a payor benefit rider is attached to the life insurance policy?
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Premium payments are waived in the event the premium payor dies or becomes disabled
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In what way is a life insurance policy affected by an accelerated benefit payment?
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Decreases the death benefit
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Which of these factors does NOT affect life insurance premium rates?
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Producer Certification
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A contingent beneficiary is described as the
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person who receives the death benefits if the primary beneficiary dies before the insured
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How much is normally paid to a policyowner in a life (viatical) settlement?
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Less than the death benefit
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Life insurance premiums are based on what three factors?
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Mortality, interest, expenses
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Where will a life insurance policy's proceeds be directed to if all the beneficiaries die before the insured?
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Insured's estate
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A signed good health statement may be collected by a life producer at the time of
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policy delivery
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What happens to the cash value of a market value adjusted annuity if it's surrendered prior to the end of the stated guarantee period?
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Subject to market value adjustment
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What is the effect of the market value adjustment in a market value adjustment annuity?
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Transfers some of the investment risk to the policyowner
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The contract owner in a single premium deferred annuity (SPDA)
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makes only one premium payment
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The interest credited to the cash values of personally-owned non-qualified annuities is considered
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tax-deferred
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Which benefit can be found in an equity indexed annuity, but not in a fixed annuity?
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Protection against long-term inflation
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When compared to a fixed annuity, a variable annuity has what distinguishing feature?
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Investment risk is assumed by the purchaser
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When a deferred annuity is surrendered, who must sign the authorization to do so?
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Owner
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An annuity's accumulation period can usually
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continue after the purchase payments stop
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Which event triggers a deferred annuity to start making benefit payments to the annuitant?
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When the contract is annuitized
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Under which circumstance is the interest rate guaranteed within a market value adjusted annuity?
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When the contract has been held for a stated time period
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What happens to the purchasing power of benefit payments from a fixed life annuity when the cost of living goes up?
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Decreases
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Sarah, age 88, is a life annuitant who has lived beyond her life expectancy. The funds for additional benefit payments will be derived primarily from funds that were
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not distributed to life annuitants who died before life expectancy
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A retirement plan that sets aside part of the company's net income for distributions to qualified employees is called a
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profit-sharing plan
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An employee requested that the balance of her 401(k) account be sent directly to her in one lump sum. Upon receipt of the distribution, she immediately had the funds rolled over into an IRA. What is the tax consequence of the distribution sent to this employee?
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Distribution is subject to federal income tax withholding
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Rick recently died and left behind an individual IRA account in his name. His widow was forwarded the balance of the IRA. The transfer of Rick's IRA account balance to his surviving spouse qualifies for
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the marital deduction
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Who is normally considered to be the owner of a 403(b) tax-sheltered annuity?
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The participating employee
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The health insurance premiums paid for by each partner in a partnership is considered to be
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100% tax deductible
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A disabled business owner who has payroll and business expenses paid for has what kind of insurance policy?
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Business overhead expense
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Pete is covered by a group health insurance plan which covers employees in multiple states. This plan is governed by the laws of which state?
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Where the master contract was issued
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Which of the following statements BEST describes a double indemnity provision in travel accident insurance?
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Benefits are doubled under certain circumstances stated in the policy
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Which of these are NOT factors that influence group health insurance underwriting?
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Physical exams of group members
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Nonqualified distributions from a health savings account (HSA) have a tax penalty of
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20%
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Which of the following is another name for individuals who participate in an HMO plan?
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Subscribers
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Which of the following statements is INCORRECT about why the government provides insurance?
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Reduce fraudulent claims
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Medicaid will pay for nursing home expenses under what condition?
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Must have financial need
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Rick is a disabled worker receiving Social Security benefits. What are his wife and dependent children eligible for?
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An income benefit which is a percentage of his primary insurance amount
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Which of these would NOT likely qualify as a presumptive disability?
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Loss of sight in one eye
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The amount of a covered loss to be paid by the insured before a major medical expense policy begins to pay is called the
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deductible amount
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Which of these statements regarding Major Medical Expense insurance is NOT true?
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Benefits are paid on a capitation basis
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A pre-existing condition exclusion in an accident and health insurance policy pertains to
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prior health matters
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A policyowner suffers a covered accident and health insurance loss on June 30 and submits the proof of loss to the insurer July 10. If the policyowner cancelled the coverage on July 2, how will the insurance company handle the claim?
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Claim must be paid after proof of loss is received
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A health plan offered by private insurance companies is
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a Medicare Supplement
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What type of doctor-ordered care assists an individual with performing basic daily activities such as bathing, dressing, and eating?
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Custodial care
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Medicare Supplement insurance requires an individual to be at least how old for open enrollment?
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No minimum age
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When a health insurance policy includes a Mandatory Second Surgical Opinion provision, the insured must
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seek a second opinion for specified elective surgeries
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The disability income policy most likely to have been issued on a substandard basis is
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Non-cancelable with a health condition exclusion rider
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Which of the following is NOT a basic underwriting action for accident and health insurance?
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Removing uniform policy provisions
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What is the name of the period of time during which a new employee is ineligible for group Health insurance coverage?
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Probationary period
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Which type of deductible must be satisfied again for each illness or accident in a major medical plan?
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Per-cause
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Which statement is NOT true regarding health insurance policies that provide limited benefits?
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Only persons under the age of 65 are eligible
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In long-term care insurance, what is the length of time for which claims will be paid?
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Benefit period
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Third-party administration has become popular in accident and health insurance due to the expansion of
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self-funding of benefits
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ERISA requires that a Summary Plan Description must be provided to a new plan member within how many days following the new member's eligibility date?
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90
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What is another name for a Keogh plan?
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HR 10 plan
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Who does TRI-CARE provide accident and health coverage to?
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Military families
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Misrepresenting pertinent policy provisions relating to coverage after a loss is
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An unfair claims settlement practice
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Making a statement that is false or maliciously critical of the financial condition of an insurer is known as
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defamation
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A producer who attempts to intimidate is engaging in
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coercion
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In accordance with federal fraud and false statements regulation, a prohibited person cannot transact insurance business in Nebraska without
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The written consent of the Commissioner
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Who reports a producer's termination of appointment to the Director?
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The insurer
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Which event must a producer report to the Director?
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Conducting business under an assumed name
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To receive an insurance license, an applicant must
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Apply for the license after passing the appropriate examination
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A licensee whose name or address changes must notify the Director within
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30 days
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Which of the following activities would NOT subject a licensed producer to a penalty under Nebraska law?
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Selling a life insurance policy to an individual who already owns a current life policy
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Basic coverage for the treatment of alcoholism includes how many days of hospital inpatient coverage in any 365-day benefit period?
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30
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Employer-paid qualified long-term care insurance premiums are typically
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excluded from the employee's gross income
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Scott has a life insurance policy in which the dividends are left with the insurance company. This particular policy may be paid up when the cash value plus accumulated dividends
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equal the net single premium for the same face amount at the insured's attained age
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A certificate of coverage for a group health policy is best described as
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proof of coverage for the employee
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Which of the following is true regarding inpatient psychiatric care under Medicare Part A?
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Benefits are limited to 190 days lifetime
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Dividends from a stock insurance company are normally sent to
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shareholders
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The main role of accident and health and disability insurance is to
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protect against medical care costs and the loss of earning power
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The coinsurance for skilled nursing facility services covered by Medicare after the 100% Medicare coverage ends is
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a flat dollar amount per day
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Ken is age 65 and has 2 years until he receives Social Security retirement income benefits. At his current age, which is true about Medicare Part A Hospital Insurance coverage?
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It is available through application to Social Security
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A preferred provider plan and an indemnity plan are similar in what way?
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Both pay on a fee-for-service basis
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Larry is about to file an accident and health insurance claim. Which of the following would make claim handling more convenient for him?
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Assignment of benefits
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Which factor determines the maximum disability income benefit that can be purchased by an applicant?
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The applicant's income
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What is the insurer responsible for when a producer is acting within the scope of authority granted in the agency contract?
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Responsible for acts by the producer that are authority only
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Which of these must be disclosed in a universal life policy?
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The surrender charges
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Which statement regarding an adjustable life insurance policy is NOT true?
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Policy loans are not permitted
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Which of these life insurance policies do NOT contain cash value provisions?
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Decreasing term life
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Straight whole life insurance can be accurately described in all of these statements EXCEPT
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Policy protection normally expires at age 65
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How are level term policies able to provide level premiums?
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Premiums are averaged over the term of the policy
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Laura added a children's rider to her life insurance policy. What type of coverage was added?
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Level term
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Which of these is NOT an advantage of term life insurance?
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A cash benefit will be provided if the insured is alive at the end of the policy period
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Peter, age 50, surrenders his modified endowment contract (MEC). How is the gain treated in terms of federal income taxes?
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The gain is treated as taxable income and a penalty tax is imposed on the gain
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Which statement regarding a single premium life insurance policy is NOT correct?
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Additional premiums may be required under certain conditions
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When a lapsed policy's premium has been paid current, it has the potential of being
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reinstated
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Which situation is an accelerated (living) benefit rider suited for?
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Insured expected to be confined to a nursing home for life
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A life insurance policy provision that has the potential to reduce the death benefit is called the
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accelerated (living) benefit
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Which statement regarding the waiver of premium rider is accurate?
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Cash payment is not directly provided to the policyowner
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A life insurance policy that includes a return of premium rider will pay the beneficiary how much upon the insured's death?
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Total premiums paid plus the policy face amount
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Which benefit is normally payable to a life insurance policyowner when the insured's life expectancy has been severely limited?
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Accelerated (living) benefit
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How may an insurance company classify an accidental death benefit on a life policy?
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As an optional policy rider
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An insured that has a guaranteed insurability rider attached to his life insurance policy has the right, without proving insurability, to
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periodically purchase additional insurance
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What is considered the collateral on a life insurance policy loan?
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The policy's cash value
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Which of these statements is NOT true regarding a cash value loan against a life insurance policy?
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Interest payments made by policyowner are deductible
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When a policy loan is requested by a policyowner and it requires the consent of the beneficiary, what kind of beneficiary designation is this?
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Irrevocable beneficiary
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Which settlement option makes minimum guaranteed dollar payments over a stated number of years?
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Fixed-Period
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Which life insurance policy provision prohibits a beneficiary from "commuting, encumbering, withdrawing, or assigning" any portion of the proceeds prior to actual receipt from the company?
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Spendthrift clause
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Death proceeds from a life insurance policy are typically included in a deceased insured's gross estate
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for federal income tax reasons
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Which report contains information regarding an individual's general reputation and credit standing?
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Consumer report
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The reason for backdating a policy is
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to obtain a premium rate based on an earlier age
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When the disclosure of an insured's nonpublic information is involved, what is the insurer obligated to do?
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Give notice, explain, and allow opting out
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Which of the following is NOT a reason for a business to buy key person life insurance?
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An increased pension liability if the key employee dies
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Employers often purchase life insurance on a key employee in order to
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help offset the cost of finding and training a replacement if the employee dies
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When does interest income for a flexible premium deferred annuity get reported for federal income taxes?
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When the distributions are received from the contract
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Who typically makes the purchase payments in an individual annuity?
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Owner
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The interest credited to the cash values of personally-owned non-qualified annuities is considered
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tax-deferred
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A life annuity feature which provides benefit payments for a minimum number of years, no matter when the annuitant dies, is called
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period certain
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When does the owner's contractual rights begin under an individual annuity contract?
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Time of purchase
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When a large sum of money is used to structure monthly payments, which product is typically used?
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An immediate annuity
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Which of the following normally pertains to an immediate annuity?
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Lack of an accumulation period
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An annuity which starts paying monthly benefits within a month after issuance is called a(n)
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immediate annuity
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When funds are transferred directly from one IRA to another IRA, what percentage of the tax is withheld?
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None
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The time limit an individual has to "rollover" funds from an IRA or qualified plan is
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60 days
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First-time homebuyers are able to withdraw up to how much from their qualified IRAs without incurring the 10% early withdrawal penalty?
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$10,000
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Which of the following is NOT a function of accident and health insurance?
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Pays a death benefit as a result of natural causes
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Typically, states will permit the grouping of two or more small employers in the same industry for obtaining group health insurance at a favorable rate. This grouping of employers is known as a multiple employer
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trust
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Individuals covered with employer-paid group health plans will normally receive tax-free benefits under all of these plans EXCEPT
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Disability income
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Individuals seeking Social Security disability income benefits must have a disability that will eventually lead to death, or be expected to last at least
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12 months
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Specialty care is provided by which of these health maintenance organization (HMO) providers?
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Neurologist
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Which of the following is NOT an allowable exclusion for long-term care insurance policies?
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Care for incurable conditions
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Which of the following does NOT meet the requirements of "skilled nursing care"?
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Must be provided exclusively in a hospital
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Who is protected with the "other insurance with this insurer" provision?
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Insurance company
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What does a Mandatory Second Surgical Opinion provision provide to an employer-paid health insurance plan?
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Containment of the employer's premium cost
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To which of the following group plans do HIPAA rules NOT apply?
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Disability income
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Which of these noncontributory group plans would a claim likely result in the payment of federal income taxes?
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Disability income
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What action can an insurer take to discourage malingering and false disability claims?
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When an insured has two disability policies with the same insurer, the insurer sets limits on the amount of benefits an insured can collect
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A medical fee schedule shows the amount an insurer will pay for a given procedure. This amount is considered to be the
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highest amount payable
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Reductions in coverage are one feature of _______ in Health insurance policies.
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cost containment
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What is a "functional assessment" for long-term care benefits?
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A review of the insured's ability to perform the activities of daily living
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Some standard Medicare Supplement policies include which benefit?
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Hospice care
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Which of the following describes coverage for the Medicare Part B coinsurance?
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A Medicare Supplement core benefit
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In long-term care insurance, what is an "ADL"?
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Activities of daily living
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The payment of the first premium, the promise to pay a covered loss, and the agreement to abide by policy conditions are all examples of
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consideration
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Emergency health care coverage for Medicare enrollees traveling abroad is
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a core benefit under a Medicare Supplement
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An attempt to defraud an insurance company is considered
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A felony
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A producer's authority to bind an insurer to an insurance contract may be granted in the:
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Producer's appointment with the insurance company
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A producer's license in Nebraska must be renewed every
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Two years
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An individual appointed by an insurance company that represents the company and presents policies on its behalf is
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A producer
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No existing producer's license will be revoked until
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The producer has been afforded a right to a hearing on the charges
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Disclosure requirements in the life insurance solicitation regulation mandate that prospective purchasers be given
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a Buyer's Guide and Policy Summary
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A nonparticipating whole life insurance policy was surrendered for its $20,000 cash value. The total premiums paid had totaled $16,000. What were the federal income tax consequences to the policyowner on receipt of the cash value?
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$16,000 was received tax-free and $4,000 as ordinary income
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A comprehensive group policy also covers expenses related to vision care. Which of the following is not typically covered under a vision plan?
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Cataract surgery
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A producer delivers an accident and health policy and must also collect the initial premium. The applicant informs the producer of a recent material change in health. Aside from collecting the initial premium, the producer must also
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obtain a signed good health statement from the applicant
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Errors and omissions insurance would be used in which of the following situations?
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A producer's improper replacement of an insurance policy